title: Staging MR lymphangiography of the axilla for early breast cancer: cost-effectiveness analysis.
abstract: OBJECTIVE
  The purpose of this study was to compare the cost-effectiveness of MR lymphangiography-based strategies with that of sentinel lymph node (SLN) biopsy alone in the axillary staging of early breast cancer.
  
  
  METHODS
  A decision-analytic Markov Model was developed to estimate quality-adjusted life expectancy and lifetime costs among 61-year-old women with clinically node-negative early breast cancer. Three axillary staging strategies were compared: MR lymphangiography alone, combined MR lymphangiography-SLN biopsy, and SLN biopsy alone. The model incorporated treatment decisions, outcome, and costs consequent to axillary staging results. An incremental cost-effectiveness analysis was performed to compare strategies. The effect of changes in key parameters on results was addressed in sensitivity analysis.
  
  
  RESULTS
  In the base-case analysis, combined MR lymphangiography-SLN biopsy was associated with the highest quality-adjusted life expectancy (13.970 years) and cost ($63,582), followed by SLN biopsy alone (13.958 years, $62,462) and MR lymphangiography alone (13.957 years, $61,605). MR lymphangiography-SLN biopsy and SLN biopsy both were associated with higher life expectancy and cost relative to those of MR lymphangiography. MR lymphangiography-SLN biopsy, however, was associated with greater overall life expectancy and greater added life expectancy per dollar than was SLN biopsy. SLN biopsy alone therefore was not considered cost-effective, but MR lymphangiography and MR lymphangiography-SLN biopsy remained competing choices. Preference of MR lymphangiography strategies was most dependent on the sensitivity of MR lymphangiography and SLN biopsy and on the quality-of-life consequences of SLN biopsy and axillary lymph node dissection, but otherwise was stable across most parameter ranges tested.
  
  
  CONCLUSIONS
  From a cost-effectiveness perspective, MR lymphangiography strategies for axillary staging of early breast cancer are preferred over SLN biopsy alone. The sensitivity of MR lymphangiography is a critical determinant of the cost-effectiveness of MR lymphangiography strategies and merits further investigation in the care of patients with early breast cancer.
authors.affiliation: Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St., 10th Fl., Boston, MA 02114, USA.
authors.forename: Pari V
authors.initials: PV
authors.lastname: Pandharipande
authors.forename: Mukesh G
authors.initials: MG
authors.lastname: Harisinghani
authors.forename: Elissa M
authors.initials: EM
authors.lastname: Ozanne
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
authors.forename: Janie M
authors.initials: JM
authors.lastname: Lee
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
mesh_terms: D001365:Axilla / Q000473:pathology; D001900:Boston / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008207:Lymphatic Metastasis; D008220:Lymphography / Q000191:economics* / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D021701:Sentinel Lymph Node Biopsy / Q000191:economics / Q000706:statistics & numerical data*